Amol Rajan: The NHS is a bedrock of our society but soon we’ll have to pay for it

Privatisation: there are two ways to fund the NHS - either through increased taxation, or through the private sector

I once heard the historian Niall Ferguson say something counter-intuitive but superficially attractive about education. The big problem in Britain, he said, is the quality of education available to the poor through the state sector, and the difference between its standards and those of the private sector, affordable only by the very rich.

The instinctive response of many egalitarians to this situation, he observed, is that we should abolish private schools. But what if you did the opposite? What if you radically increased the number of private schools? Sure, more people would have to pay — but increased competition could lead to lower costs, and the reduced burden on the state sector could perhaps be passed back to the masses via lower taxes.

I was amazed to discover soon after that in India hundreds of millions of middle-class parents do pay for education. Only the very poorest get free schooling.

Alas, this argument doesn’t always work, because private schools actually impose a cost on state schools. By taking many of the brightest and most motivated pupils, and those with the greatest social capital, they lower standards and horizons in the state sector. In education, we need the ethos and commitment to excellence of private schools in the state sector. This is the animating vision of free schools and academies, by the way.

In health, however, the Ferguson argument makes sense. If more middle- class people expected to pay a greater proportion of their disposable income on their own health, they would reduce the burden on the NHS.

Whereas there are good pupils for schools to have, there aren’t good patients for hospitals to have. If many more people spent money on their health — whether through vouchers, insurance schemes or direct payment — the NHS would be better off.

Everybody knows that the NHS is financially broke. It faces a £30 billion hole within just six years. Logically, there are two places that money can come from. First, the state, through taxes. In case you hadn’t noticed, the next government is going to make what the Institute for Fiscal Studies calls “colossal” cuts. So rule that out. Second, through the private sector — that is, you paying private providers. This could increase productivity, and reduce the strain on an NHS that is currently in crisis mode.

Everybody also knows that the NHS is toxic for the Tories, that “privatisation” of any kind is taboo in Britain, and that Nigel Lawson was right to say the NHS was the nearest thing we have to a religion. I for one feel I owe it more than the nurses and doctors who saved my mum’s life will ever know.

But in terms of policy and public expectations, the NHS has entered the realm of superstition. For a noble institution that treats people in need, and is buckling under pressure that will soon grow sharply, this is a bad place to be.

You’re used to very high-quality healthcare, free at the point of delivery, but funded by your taxes. Very soon, you’re going to have to get used to paying a lot more for it. Do you want control over how you pay for it, or not? If you do, get real, and face up to the inevitability of privatisation, in some form at least.